title: Fibroscan can avoid liver biopsy in Indian patients with chronic hepatitis B.
abstract: OBJECTIVE
  Liver fibrosis is an established determinant of prognosis and therapy in chronic hepatitis B (CHB). The role of fibroscan in assessing fibrosis in CHB remains unclear. Present study was designed to correlate fibroscan with liver biopsy and determine whether fibroscan can avoid liver biopsy in patients with CHB.
  
  
  METHODS
  Fibroscan and liver biopsy were performed in 382 consecutive patients with CHB. Biopsies were reviewed by pathologist blinded to the fibroscan value. Discriminant values of liver stiffness measurement (LSM) to reasonably exclude and predict significant fibrosis were calculated from receiver operating characteristic (ROC) curves. The factors affecting LSM independent of fibrosis were assessed.
  
  
  RESULTS
  Three hundred fifty-seven patients were included (mean age 30.1 ± 9.7 years, male : female 17 : 3). There was significant correlation between LSM and histological fibrosis (r = 0.58, P < 0.001). The area under ROC curve of LSM for significant fibrosis (F0-1 vs. F2-4), bridging fibrosis (F0-2 vs. F3-4), and cirrhosis (F0-3 vs. F4) was 0.84 (95% CI: 0.78-0.89), 0.94 (95% CI: 0.89-0.99), and 0.93 (95% CI: 0.85-1.00), respectively. LSM < 6.0 KPa could exclude significant (F ≥ 2) and bridging fibrosis (F ≥ 3) with a negative predictive value (NPV) of 92.4% and 99.5%, respectively. Cut-off of 9 KPa could detect significant (F ≥ 2) and bridging fibrosis (F ≥ 3) with specificity of 95% and 97%, respectively, and had a positive predictive value (PPV) of 84.3% in predicting significant fibrosis. LSM < 6 KPa and > 9 KPa matched with histological fibrosis in 227/250 (91%) patients. Therefore, fibroscan could avoid liver biopsy in 70% (250/357) patients with an accuracy > 90%. Histological fibrosis, ALT > 5 times, and age > 40 years were independent determinants of increased liver stiffness.
  
  
  CONCLUSIONS
  Fibroscan accurately assessed fibrosis and could avoid liver biopsy in more than two-thirds of patients with CHB.
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rohit
authors.initials: R
authors.lastname: Goyal
authors.forename: Saumya Ranjan
authors.initials: SR
authors.lastname: Mallick
authors.forename: Mousumi
authors.initials: M
authors.lastname: Mahanta
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kedia
authors.lastname: Shalimar
authors.forename: Rajan
authors.initials: R
authors.lastname: Dhingra
authors.forename: Hanish
authors.initials: H
authors.lastname: Sharma
authors.forename: Prasenjit
authors.initials: P
authors.lastname: Das
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Datta Gupta
authors.forename: Subrat
authors.initials: S
authors.lastname: Panda
authors.forename: Subrat K
authors.initials: SK
authors.lastname: Acharya
mesh_terms: D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D007194:India; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000410:Alanine Transaminase
keywords: age; alanine amino transferase (ALT); chronic hepatitis B (CHB); fibrosis; liver stiffness